Can Carotid Endarterectomy be Performed Safely within 14 days after Intravenous Thrombolysis for Acute Stroke?

Autor: Antonio Manca, Patrizia Dalla Caneva, Jorge Samuel Cabrera Morales, Genadi Genadiev Georgiev, Stefano Camparini, Antonio Baule, Giuseppe Deiana
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Time Factors
medicine.medical_treatment
Carotid endarterectomy
030204 cardiovascular system & hematology
Risk Assessment
Brain Ischemia
Time-to-Treatment
030218 nuclear medicine & medical imaging
Disability Evaluation
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Fibrinolytic Agents
Risk Factors
medicine
Humans
Carotid Stenosis
Thrombolytic Therapy
neoplasms
Stroke
Aged
Retrospective Studies
Acute stroke
Endarterectomy
Aged
80 and over
Intracerebral hemorrhage
Endarterectomy
Carotid
business.industry
Retrospective cohort study
Recovery of Function
General Medicine
Thrombolysis
Middle Aged
medicine.disease
digestive system diseases
Surgery
Stenosis
Treatment Outcome
Administration
Intravenous
Female
Cardiology and Cardiovascular Medicine
business
Zdroj: Annals of Vascular Surgery. 66:385-389
ISSN: 0890-5096
DOI: 10.1016/j.avsg.2019.12.038
Popis: Background Carotid endarterectomy (CEA) represents a standard procedure in case of symptomatic carotid stenosis of 50–99% within 2 weeks from onset of stroke or transient ischemic attack (TIA) symptoms. The optimal time to perform CEA after intravenous thrombolysis (IVT) is still unclear. The aim of this study was to analyze the safety of CEA performed within 2 weeks from IVT. Materials and methods A consecutive series of 70 patients affected by symptomatic carotid stenosis have been treated as per the international guidelines during 3 years. Eleven (15.7%) patients have been treated with IVT before CEA for ischemic stroke; remaining 59 (84.3%) patients received only CEA. CEA was performed in median 8 days (range: 2–13) after IVT. We examined the grade of disability before and after surgery as well as at 3 months follow-up, using the modified Ranking Scale (mRS). Results Among the patients who underwent CEA + IVT, CEA was performed in median 8 days (range: 2–13) after IVT. One patient received CEA within 48 hours from IVT, 3 patients within 72 hours, and 7 patients within 2 weeks. The complications within 90 days from surgery, in CEA + IVT group, were 3 cases of intracerebral hemorrhage (ICH) without symptoms. In patients who received only CEA, the complications were 1 case of stroke and 2 cases of ICH. The mortality registered was 0% in both groups. Among CEA + IVT group at 90 days after surgery, 9 patients had a mRS grade of 0–2, 2 patients had mRS of 3–5. Conclusions In our series, IVT before CEA did not seem to increase the rate of complications. However, the study has several limitations, and further studies must be performed before solid evidence is available for recommendations regarding the timing of CEA after IVT.
Databáze: OpenAIRE
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